Organization
SHOPKO OPTICAL MANUFACTURING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL BETTIGA RPH (SR. VICE PRESIDENT HEALTH SERVICES)
(920) 429-4297
Entity
Organization
Contact information
Practice address
1450 W MAIN AVE, DE PERE, WI 54115-9369
(920) 429-7253
Mailing address
1450 W MAIN AVE, DE PERE, WI 54115-9369
(920) 429-7179
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38456800
—
WI
Enumeration date
11/20/2008
Last updated
02/24/2009
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